Disinfection of items is a common practice in health care facilities. Usually disinfection of surfaces and common use items is done using a chemical disinfectant. The reasons for disinfection are clear: Decrease the number of microorganisms that can cause odor, discoloration and illness.
In the skilled nusring facility, disinfection of floors, walls, commodes, bed rails, night stands and sinks is done by the housekeeping department. Their role as part of the facility's infection control program is frequently overlooked. A common mode of transmission of microorganisms is indirect contact with environmental surfaces. The appropriate disinfectant can help reduce the risk of infection.
One area that is frequently overlooked is the bedside. There are many items kept at the bedside, which are reused by the resident and which never get cleaned! Specifically, the bedpan, urinal, wash basin and kidney basin. While these items are made of disposable plastic, they can and should be disinfectant on a regular basis. Rinsing a bedpan after use and placing it back into the resident's bedstand creates a potential reservior of infection.
The standard for disinfection for water pitchers is usually for the pitchers to be collected and sanitized daily. This can be the standard for bedside items as well. The bedside item can be disnfectanted using a chemical disinfecnt, such as the one used for general cleaning, providing it is a detergent-disinfectant which can be used on non-porous surfaces. Follow the label directiuons for correct usage.
There are three systems you can choose to use:
- Disinfect the item after each use and place it back at the bedside. This is labor intensive and time consuming for the busy nursing assistant.
- Place the used item into a large barrel for disinfection later, and replace it with a clean item. Clean items can be stored in the utility room.
- Rinse the item after use and place it at the bedside. Then the housekeeper replaces the item daily as part of the routine room cleaning procedure. The used items should be disinfected and placed back into use the following day. This system requires at least two sets of bedside items.
Disinfection should be done according to the manufacturer's recommendations. If you are using a chemical disinfectant in California, you need to apply for program flexability for sanitization of bedside items.
Evaluate the disinfectant. Look for the label claim to be bacteriocidal, virocidal, and fungicidal. One of the most common misuses of disinfectants is incorrect dilution and incorrect amount of contact time. Most disinfectants use a 10 minute contact minimum. This can be accomplished by wiping the item and allowing it to air dry. Soaking or submersion is not necessary. The disinfectant should be diluted as recommended. Too much disinfectant wastes money and may decrease the life of the item.
Another frequently overlooked item which requires regular disinfection is the electronic thermometer and blood pressure cuff. The housekeeping department usually does not clean medical equipment. Assign some to clean the common use medical equipment. See that they use the apporpiate cleaner as recommended on the product label.
Regular cleaning of bedside items will reduce a potential resourvior of infection. This is especially important when controling infections improves resident outcome and comfort.
Mantoux Skin Testing
Mantoux skin testing is the perferred method of tuberculosis screening for residents and staff of skilled nursing facilities. It provides the most reliable measurement system for identifying those who have been exposed and are infected with Mycobacterium tuberculosis. The method, however, is not perfect. The following items are some things to consider when skin testing:
- Test solution should be 5 TU of purifed protein derivitive (PPD). The concentration of the solution was made more stable in 1978.
- The injection should be done intradermally using a tuberculin syringe.
- The test should be read by a trained professional and never by the person getting the test. It should be read within 48 to 72 hours after administration. It can be read up to one week after administration if it is positive. If the person fails to have it read within 72 after administartion, and it is negetive, the test should be repeated.
- If the test is negative, it should be repeated in one week if the person has not been tested within the past 12 months. This applies to the majority of new residents and employees who may have worked outside of health care prior to coming to your facility. This is referred to as two-step testing.
- The test should be recorded in millimeters (mm) of induration. This means if there is no induration, it should be recorded as Zero mm. Do not just write "Negative."
- Use the 5 mm cut-off point for those in the high risk group for tuberculosis, including those known or suspected of having HIV infection.
- Use the 10mm cut-off point for all others tested. This recommendation applies to anyone living in California. The CDC uses the 15mm cut-off point for the general public. Check with your local TB control for their policies on interpretation of Mantoux skin testing.
- Use only trained and qualified staff to administer and read Mantoux skin tests. The San Diego TB Control Department offers free classes, call 619-692-8620 for more information.
- For anyone with a compromised immune system, ask the physician about anergy testing. This will decrease the chance of a false negative test.
- A positive skin test can be caused by factors other than M. tuberculosis, such as nontuberculosis mycobacteria and BCG vaccine. However, a history of BCG vaccine is not considered when administering or interpreting Mantoux skin test.
The CDC has educational materials about TB which are free of charge, call 404-639-1819
James Marx © 1998
